Critical Care with Covid-19: Bottoms Up

Photo by Pim Chu on Unsplash

I went back to work this week. It’s controlled chaos most of the time (occasionally it’s straight up chaos). We have expanded beyond main ITU into Theatres Recovery, Day Surgery and Theatres Admission Lounge. They are set up to varying extents, but are pretty spread out across the hospital so moving stock and equipment between them is a challenge.

Normally one ITU nurse would look after one patient, at the moment we are working at around 1 ITU nurse to 3 patients with the support of a non ITU trained nurse or operating department practitioner (ODP). We’re having to change the way we work quite drastically at times. Normally with one patient each, you get to do everything for your patient. This is great because everything we do interlinks and you get a really good overview of the whole person. It is simply not possible to replicate that when your workload has just been tripled. There’s a reason it’s usually 1:1- that’s more than enough work to keep you going for your whole day. When a person is very sick sometimes it works out more like two nurses to one patient. We are all finding it hard to adjust because we normally give outstanding care and now we have to accept that we just cannot deliver to the same standard. You feel like you’re failing your patients, even though rationally, you know it’s simply not possible to do all that you want to.

We are now working more in teams. We have a team goes around and repositions everyone, designated nurses who just take care of the medications. It varies day to day, but it definitely works better this way when we’re very busy. We have also been using a Proning team. Proning means lying someone on their front. It’s something we do from time to time for people who are failing to oxygenate well. It seems to really make a difference in Covid patients, so is being used much more frequently now. It works because when you lay on your back various bits of your lungs get squashed. The bases get a bit squashed if you are even slightly slumped in the bed, and the flatter you are laid down the worse it is. Your heart and the surrounding vessels are also a big lump in your chest which falls back onto your lungs. So when you roll someone onto their belly, their heart falls forward onto the front of their rib cage and all the lungs in the back of their chest (which is the bigger portion) have more room to expand. There’s a good evidence base for certain groups of patients, and it’s been around a while. What’s new is getting conscious patients to prone themselves! It seems a bit odd asking your patients to roll themselves over and lie on their belly and we are definitely get some funny looks, but it really seems to be helping! So it’s bottoms up for now!

As we all know, we’re expecting an unprecedented increase in demand. The unit is usually 12 bed, the original plan was to expand to 48 beds but I’ve heard we’re now aiming for 100. There are already not enough ventilators. We have people being ventilated on transfer vents, which are not designed to keep people on for long periods. They’re just a bit more rudimentary and give us less control over how they’re being ventilated. Some are on anaesthetic machines (the machines they use in theatres if you have an operation), which again, are limited in what they can offer because they’re only designed for short term use. There are more ventilators on order, but we are still waiting for them to arrive.

As I walked in mid-week, I was confronted with a stark reminder of the situation we are in. An additional mortuary has been constructed. More people sick means there will be a proportional increase in the number of people dying.

Stay home, don’t get sick, keep yourself and your loved ones safe.

Critical Care Nurse, Masters Student, Really not a morning person.